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Dentures Without Implants are for Smiling Not Chewing

4/7/2021

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I belong to several online dentist groups where dentists discuss cases and treatment plans together to try and further their education.  Last week, one of the dentists posted this title, “Dentures without implants are for smiling, not chewing,” and it really resonated with me.  
In the beginning of my career, I would happily complete a lower denture on anyone who wanted and/or needed one.  I had learned the best techniques and was taught that in cases with hopeless teeth, dentures were standard of care.  Over the years, I began to realize that my denture patients and specifically my patients with conventional lower dentures, were my “problem” patients.  They were the patients who were never happy.  They often just couldn’t function with the lower denture.  So, I took a denture course.  I thought surely it was something I was doing wrong.  And, thanks to an amazing dental school (Go Gators!), I didn’t learn any new techniques.  I was taught, and was doing the best techniques for completing dentures that were available.  
My next plan of action was to create a new policy for myself.  And, this is the policy I have stuck with for many years now.  I just don’t do lower dentures without implants anymore.  I hate when patients are unhappy or disappointed.  I want to know that when I finish my work, I will have a happy, healthy, functioning patient.  I couldn’t guarantee that with lower dentures without implants.  Don’t get me wrong, there are some patients who are completely happy with anything.  You literally put a denture in their mouth and they happily start chewing and functioning with it and never look back.  But, those patients are few and far between.  The rest of the time, patients who get conventional lower dentures are sorely disappointed.  They can’t eat and often can’t speak properly.  Most of the time, they end up putting the dentures in a drawer and only using them for special occasions.  
So, what is the difference between upper and lower dentures?  People think, well I have 2 jaws, so they must be the same.  This couldn’t be further from the truth.  As I would tell my patients, most people can tolerate an upper denture.  While it is not the most fun experience, and it is definitely not like having your own teeth, most people can learn to function with an upper denture.  Lower dentures are a whole different ballgame.  Let’s talk about the difference between your upper and lower jaws.  Feel the roof of your mouth with your tongue.  It is mostly hard, and where the hard part meets the soft part, back by your throat, this is what helps the denture suction to the roof of your mouth.  Now feel your lower jaw.  Most of it is covered by your tongue and it is soft moveable tissue in the middle of your teeth.  Your jaws are completely different.  Therefore, the dentures have to be completely different.  An upper denture covers the entire roof of your mouth.  It has a lot of surface area to help it suction and have retention.  
A lower denture on the other hand is horseshoe shaped.  It follows the horseshoe area where your teeth would be, but the entire middle is left open so that your tongue has space to move.  But it doesn’t stop there.  Not only is a lower denture missing all that area that creates suction, but in addition, there is nowhere for the lower denture to suction.  Your tongue is attached to the floor of your mouth in the middle of your lower jaw.  Every time you speak or chew, your tongue moves and it moves all of that soft tissue around it.  Most of the time, this displaces a lower denture.  This is what makes lower dentures intolerable for most people.  Unless you have the patience to retrain your mouth to use your tongue and cheek muscles to hold the lower denture in place, then it will be a miserable experience.
Now you can see why the above quote resonated with me.  I have been trying to find a succinct way to explain my policy on dentures to my patients for years…and there it was.  Often people don’t realize how big of a difference just two implants underneath a lower denture can make.  It turns a vanity item into a useful appliance.  Throughout the years, my patients that have gone from a conventional lower denture to an implant supported denture are always my happiest patients.  I can’t even tell you how many of them have told me that it changed their life.  They can go back to chewing and eating foods that they haven’t had for years.  They can socialize without fear of their denture moving around during conversation.  And for many it even changes their intimate life as well.  They feel so much less self conscious.  It is always amazing to me how two little snaps can truly change a person’s life.  I could honestly go on speaking about it for hours!   I won’t bore you with the details, but if you or someone you know is suffering, or just “getting by” with a lower denture, I implore you to look into getting two implants on the bottom.  With payment plans, it is more affordable now than ever and it will change your life.  Let’s get you back to smiling and chewing again!
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Are My Missing Teeth Making Me Fart?

4/2/2021

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More than 70% of the adult population in the US is suffering from digestive symptoms and diseases.  So, it is now more important than ever to understand what is leading to your digestive issues.  We’ve all heard about heart burn, GERD, Crohn’s and the myriad of other digestive diseases, but how do your teeth come into the mix?  Teeth are the beginning of the digestive process.  Chewing food is the first step in converting your food into the molecules that the body needs.  Research has actually proven that the ability to chew your food properly is just as important as the quality of food you eat!  
As a dentist, I have had patients come to me more times than I can count and they just want to fix their front teeth.  They want me to pull the back ones, as long as their smile looks good.  Here is just one of the problems with that.  Not all teeth are alike.  We all know this, but until you actually think about it, you may not realize that are teeth are specifically placed where they are needed.  Your front teeth, or incisors, are made for cutting or tearing food.  They are too delicate to put the amount of force needed to actually chew food on them.  This is why when people lose their back teeth, they start having problems with their front teeth.  Your next teeth back, the premolars, are basically a hybrid between a front tooth and a back tooth.  They can cut and tear a little and they can crush food a little, but they are not adept at doing either very well.  They are the quintessential middle man.  Your back teeth or molars are the key to good digestion.  Their size and design helps to grind and crush the food you eat into little particles that are easy to chew and digest.  
The next problem is misalignment of teeth.  If a tooth is lost and not replaced in a timely fashion, teeth will start to shift.  Even a shift of a millimeter is a huge change in your mouth.  It can take teeth that fit perfectly together and make it so all of your teeth are only contacting at one point in your mouth.  This makes proper digestion impossible.  Think about a time when you got a seed of some sort stuck in your tooth.  I’m a big raspberry fan so this is the easiest analogy for me.  That tiny raspberry seed stuck on top of your tooth feels like a boulder.  Your bite immediately feels off and I personally have to take care of it before I can keep eating.  When your teeth shift after you lose one, it is the same phenomenon, but it happens gradually and often people are completely unaware that it is happening.  Over months and years their bite just changes and they adapt to their new bite and then wonder why all of the sudden they are having all of these new digestive issues popping up.  
Obviously, there are thousands of reasons why you might be having digestive issues.  However, if you want to start at the beginning, keep in mind that the first step is having a good bite and chewing your food properly.  There are so many different ways to replace missing teeth and restore proper function.  Nobody should have to suffer with digestive issues.  Let us help get to the root of your problem so you can feel good again!

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How to Save Money at the Dentist

3/24/2021

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I promised a follow up in my last blog about the best way to get affordable dental care and here it is!  It’s going to seem counterintuitive and you may not like it, but this is it!  The best way to avoid expensive dental care is to go to the dentist.  
    Let me explain.  Think of a new car.  As long as you get your oil changed and your brakes and tires fixed at the right intervals, then unless you have a lemon, all is good!  Your mouth is the same way.  Everyone starts with a clean slate.  Most people are born with a perfect set of teeth.  It’s what we do to those teeth that causes problems.  However, if you go to the dentist for regular check ups, two things happen.  
    The first is that we clean your teeth thoroughly which you can’t do at home without training.  This is important, but not as important as the second.  The most important thing we do is x-rays and an exam.  This is your money saver.  And here is why.  
    If you go to the dentist regularly and start to get a cavity, when a cavity is small, a filling can be done.  A filling costs between $250 and $500 depending on where you live.  While this is significant, it is nothing compared to what will be needed if you don’t catch the cavity fast.  
    Take that same tooth and wait a year or more and now that cavity can no longer be filled with a filling.  The cavity is too big and filling material is only made to support a certain amount of pressure on it.  Therefore, once you are missing more than 50% of tooth structure, you need a crown so that the tooth can still be used without breaking more.  A crown will cost around $1000-$2000 or more depending on where you live.  So, now your price has at least doubled.  
    Take that same tooth and wait another 6 months to a year.  The cavity will continue to grow and once it reaches the nerve there are only two options.  Option 1 is to save the tooth and do a root canal.  The root canal alone will cost anywhere from $1200-$2500 depending on where you live and then you still have to restore the tooth.  This requires a post and build up as well as a crown.  Now you are looking at a minimum of $2600 to over $5000 depending on where you live.  Again your cost has doubled.  Option 2 is to pull the tooth.  Which leads us to our next scenario for the same tooth.  
    If you wait longer on the same tooth, it will no longer be restorable.  Now you have to pull it.  This is usually your cheapest option which leads people to think, “why go to the dentist?”  But, pulling a tooth is by far your most expensive endeavor.  Yes, the actual extraction will probably only cost between $150-$500 depending on where you live.  However, you are getting rid of a vital piece of your body.  It begins a domino process of problems in your mouth and body.  
    Once a tooth is pulled, your body is genetically programmed to try to replace that space in your mouth.  The tooth’s purpose was to help you digest your food, so your body is trying to help you achieve that in the only way it can.  The tooth next to the space will start to lay over into the space, and the tooth opposite it will try and grow into the space.  This was a great solution back when we were cave people and didn’t have a long life expectancy because it is a good short term solution from the body.  Over time, however, this domino effect of the teeth will make you lose more teeth, as well as jawbone.  As you lose more and more teeth, you cannot digest your food properly which leads to a myriad of digestive problems as well as overall health problems because your body is unable to absorb the nutrients it needs.  Again this leads us to a different blog which I will cover next time.  So, I will finish today’s with this.  Losing a tooth leads to a domino effect that at a minimum will be the cost of an implant, and at a maximum will cost you the decline of your health over time.  
    So, don’t put off your trip to the dentist, or your dental work that’s needed.  It will only end up costing more money and pain the longer you wait.  Believe it or not, this is actually another dental secret I’m letting you in on!  Dentists don’t make any money on our “good” patients.  We love to see you, and you become like family.  My favorite patients are the ones I can count on like clockwork.  I love to catch up with them and keep up to date on their families and travel.  But, the patients that don’t come in for 5-10 years is what keeps dentists in business.  So, if you’re looking to help out your local dentist, don’t come in for years.  But, if you’re looking to get the most inexpensive dental treatment, become a regular. 
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Why is My Dentist So Expensive?  Is My Dentist Overpriced?

3/11/2021

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The question heard around the world…why does this cost so much money?  I’m going to let you in on some dental secrets today.  The costs to operate a dental office are soooo expensive.  A well run dental office has an overhead cost of 85-90% before the dentist is even paid, and that was before Covid.  Covid has been a game changer, which is why you see so many dental offices shut down.  No one besides dentists really understand the nuances of running a practice, so I’m going to let you in on the secrets.  
Let’s start with staffing.  A typical dental office needs at least one front desk person, 2-3 dental assistants, a hygienist, and a manager to keep the office flowing.  Since Covid, staffing has been the biggest issue.  It is near impossible to find staff and when you do find them, they want significant pay raises from what they have historically been paid.  By the time the 6 employees are paid not including the doctor, the grand total is 
Grand total = $20,000-$25,000/mo


Next we have the typical rent and utilities.  Obviously these vary greatly depending on location, but I will give you an average of our practices.  
Rent $4300/mo
Phone $500/mo
Internet $150/mo
Electric $450/mo
Water $350/mo
Grand total=$5750


Equipment Cost.  Most people don’t realize the massive cost of all of the equipment in a dental office.  The minute that the word dental is attached to anything, the price skyrockets.  Just one of the “run of the mill” not anywhere near top of the line chairs that are required to perform dentistry in will run you anywhere from $15,000 to well over $50,000, and that is just the chair.  It doesn’t take into account that you have to plumb the building to the chairs.  You then have to add in all the equipment, the drills, the instruments, the drill-bits, the equipment to sterilize all the instruments.  Dental offices come with a hefty price tag and in order to stay current, the price tag never goes away.  One digital x-ray sensor costs well over $10,000 and they break about once a year.  The point of this paragraph, is that practices almost always have some sort of equipment loan that has to be paid.  Again this has a huge range.  But typically speaking, one dental operatory room costs anywhere from $35,000 to $100,000 and most practices have an average of 5.  We have equipment loans ranging from $5000-$20,000/mo.  
Grand total average: $10,000/mo


Supplies:  This is another big one.  Since Covid, the cost of gloves has risen to literally about $1/pair.  So, every time the doctor and assistant walk into the room, it is $2, and we all know how many times they come in and out.  Add to that, that the average cost just to set up the room with disposable supplies for each patient is~$25, you will see why the average dental practice supply bill is well over $7500/mo.  


Advertising:  This isn’t your grandparent’s country anymore.  In this world of just about everything corporate, even the dental offices have changed.  When my husband and I bought our first practice, we bought it from a dentist who had been there for 35 years.  He had never done any advertising.  He knew the 4 other dentists in town, they were all friends, and everything worked out.  It was ideal.  Life was good.  Then Coast opened in town.  Aspen and Heartland followed, and we started down the road to going out of business.  It is hard to compete with a huge beautiful dental office that people see every day because it sits in front of Walmart.  We began advertising just to remind people that we were there.  This has become the standard now.  Corporations have driven all dental offices to have to advertise in order to stay alive.  I can’t even wager a bet on a typical monthly advertising budget, but I know all of ours exceed $12,000/mo, so I will put that to be safe.  


Labs:  Lab technicians are the middle men in dentistry.  Dentists create the work and finish the work, but we aren’t taught how to do the middle work.  We need trained technicians to make the crowns, dentures, and other appliances that we put in your mouth.  Lab bills are variable depending on how much work is completed in the month, but you will rarely have a month where the lab bill is under $15,000.  


Merchant Fees:  Most offices now try and help patients by offering payment plans.  We use third party financing to try and help patients get the care they need.  The third party company offers the patients a monthly payment based on either interest free payments or extended payment plans depending on what the patient wants or can afford and the practice pays the third party company the remainder of the “discount” the patient is receiving.  Therefore, for every patient the practice helps, the practice looses at least 10 percent of that payment.  


So let’s add up the month.  
Payroll:    $22,500
Rent and Utilities: $5,750
Equipment:     $10,000
Supplies:    $7,500
Advertising:    $12,000
Labs:        $15,000
Merchant Fees: varies minimum $5000


Grand Monthly Total: $77,750 on the very low end.  
Every month on the first day of the month, regardless of anything else, this is the bill to open the doors of a typical dental office, and that is without the dentist making a cent.  It doesn’t even take into account repairs or all the incidentals that add up in the month.  It is a tough nut to crack every month, and I hope it gives you some incite as to why dental fees are what they are.  We are trying to cover expenses, pay our staff, and our bills, and hopefully have a paycheck to take home and feed our own family.   If you look at the yearly totals, the practice has to generate at least $900,000 before the dentist will start getting a paycheck.  


Now, those of you who know me, will look at my facebook page and call BS.  If you look me up, you will see that I lead a beyond charmed life.  However, my life is not financed by our dental office like so many people assume.  I am not your typical dentist, and if you’re interested, I will tell you the story of how we got here.  My husband and I graduated dental school within a year of each other.  We took our first associate jobs together in an office in my husband’s hometown.  Our first year out of school, we lived with my mother-in-law so that we could pay off debt from school and try and make ends meet.  About a year into our careers, my husband determined that we should open our own practice.  You will see in my story that it is always my husband with the ideas.  We joke that he is the dreamer and I’m the worker bee.  But, that’s what makes us a great team.  We were so excited to open our first practice.  Like I mentioned above, we bought this adorable practice from a dentist that had been in the community for over 35 years.  We thought this was the beginning of our dream.  We could not have been more wrong.  At the time, I was 26 and my husband had just turned 30.  I can honestly say I looked like I was still a teenager.  When we would walk in to see the patients in this beautiful practice we had just spent a lot of money on, the patients were dismayed to see, not their beloved dentist of 35 years, but someone they considered to be a kid.  Within 2 months, we were going bankrupt.  We were so far in debt and credit card debt, I thought we were going to loose the practice.  I will never forget driving home from our beautiful office and crying to my husband, as we wondered what we were going to do.  We called some friends who owned practices and started taking management courses, and little by little, we crawled out of debt.  We learned how to manage staff and all the ins and outs of a dental office.  
About two years into owning the practice, my husband said we have to do something else.  Long term, this isn’t going to be enough for us to have a good life.  While we were making ends meet, we were never going to lead the life he envisioned for us.  He said, “You hold the fort, I’m going to open another office.”  I thought he had lost his mind.  We are both only children, who pretty much always think we are right, so you can only imagine our spirited discussions following his announcement.  But, eventually, he won.  He opened our second office, and it was much like the first.  A few months of nail biting and wondering if we were not only insane, but if we were going to go out of business times 2.  Then, it slowly turned around.  Now, we had two offices that were each making a little and a little times 2 is better than a little times 1.  And we kept building and never looked back.  That was over ten years ago.  My husband’s vision along with long hours at home and work and careful planning, has allowed us to live a life I never dreamed possible.  But, like I said, we are not your typical dentists.  I look at my dental friends online, and I know that so many of them are struggling.  They have gone deeply in debt to build and equip beautiful practices so that they can give the very best to their patients, and so many people don’t realize the stress that goes into that.  There is a reason why dentists have the highest suicide rate.   
So, the next time your dentist tells you that you need a crown and you wonder why on earth it costs so much money, remember that you are not paying just for a crown.  You are paying for the office to be there and the staff to be there so that we can provide dental services to the community.  We want to be there to help the people that are in pain, or who broke their front tooth.  Dentists go into dentistry because we truly like people, and we want to help them.  No one trains us in business, and no one ever tells us that in order to be a dentist, you are going to have to learn how to truly manage finances in an office in order to stay open and provide these services that you spent years learning and perfecting.  Most communities have a standard dental fee for every procedure.  As a consumer, as long as you stay around the average, you are paying for your crown, and everything that allows the office to be there so that you can get the dental help you need.   When you pay the dentist, you are investing in the community and most of all your own health, but that’s a topic for next week.  


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What is an All on 4?

3/3/2021

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There are commercials and information or should I say, misinformation, all over the place now about All on 4’s or Hybrid dentures.  I have so many patients asking questions about it.  The commercials from the big corporations make it seem like a perfect fairy tale, so I figured I would go over the facts.  
Let’s start with the basics.  You know, Who, What, When, Where, Why, and How.  
Who needs it?  Very few people “need” a hybrid denture.  There are certain cases where people cannot tolerate dentures, either due to anatomy or a bad gag reflex.  However, in general, hybrid dentures just improve quality of life.  They allow a patient who is either already suffering with dentures, or whose teeth are hopeless, to go back to the feeling of having a full set of teeth.  The chief complaint of patient’s with dentures is they can’t eat, talk, and function the way they used to.  Typically, salads and hard to chew foods like steak are off limits.  Hybrid dentures allow the patients to return to a normal quality of life and eat any food just like having regular teeth.   
What is it?  An all on 4 or a hybrid denture, is a dental prosthesis that is made from a combination of acrylic and porcelain.  It is screwed into the 4-6 implants to hold it in place…so that it is permanent in the sense that only the dentist can take it out.  
When: Hybrid dentures can be completed either after you have had all your teeth removed and already have dentures, or they can be done at the same time as the tooth removal.  
Where:  This is tricky.  Obviously I am extremely biased to our office.  We have a board certified Periodontist whom I have personally worked with for the last 15 years.  Without this kind of personal knowledge, there are a few things that I find imperative to look for.  First of all, ask questions.  Be certain that your provider has done several hybrid dentures.  Every mouth is different, and you want to be sure that if a situation arises, your provider knows how to handle anything that comes their way.  I would recommend an experienced surgeon.  It’s one thing to be able to perform the procedure, but it’s quite another to deal with any complications or unusual complexities that may arise.
Why:  This is the fun one!  Quality of life.  Never having to worry about your denture moving around while you are speaking, or singing, or socializing.  Being able to eat any food again.  Being able to taste food properly again without the roof of your mouth being covered.  Not having a big chunk of plastic moving around in your mouth.  The better question is, why not?
How does it work?  This depends how your mouth is to begin with.  People who already have dentures have a completely different experience than people who still have their teeth.  In both cases, the road to a hybrid denture is not a short one.  Many of the big companies that advertise tell you that it can be done in a day.  While this is true, it is not optimal or even advised.  Imagine planting a tree and then tying something to it that moved it around and around.  What would happen to the root system?  Would it be allowed to grow and become stable?  This is similar to what happens to implants when hybrid dentures are restored in the same day.  An implant is a screw that is screwed into the jawbone.  Over 2-6 months, the bone actually grows around it and stabilizes it in the jawbone becoming a part of the body.  This occurs when the implant is left alone and no force is applied to it.  When the implant is not left alone to heal and/or exposed to forces from a restoration like a hybrid denture, it does not allow the bone to properly heal around it and become part of the jawbone.  The healing process is as essential to the procedure as the placement of the implants.  


I hope this clears up some of your questions about hybrid dentures.  I think they are, by far, the most exciting procedure in dentistry today.  In the not too distant past, people who lost their teeth had no options.  Then when implants first entered the scene, if you wanted something that was permanent in your mouth, it was literally hundreds of thousands of dollars.  Now, we can offer something that will literally change the rest of your life, and with financing, most people can afford it.  Please reach out with any questions.  I would love to tell you more about this amazing addition to the world of dentistry.  

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So What’s the Deal With Wisdom Teeth?

2/3/2021

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Wisdom teeth are a hot topic, even among dental professionals.  If you stick 10 dentists in a room with an x-ray of some wisdom teeth, odds are you will get 10 different opinions on how to handle the patient.  That being said, all I can do is teach you what I learned in school and through the years.  
So let’s start out with the basics.  Why do we have wisdom teeth if we need them taken out?  Wisdom teeth are left over from our ancestors.  Basically, in cavemen days, humans didn’t practice any oral hygiene and were really rough on their teeth.  Therefore, teeth are genetically programmed even today to move forward in your mouth.  For instance, if you were to chomp on bones like our ancestors did and loose a front tooth, the other teeth in your mouth are constantly applying force in a forward direction to fill that space.  Wisdom teeth, also known as 3rd molars, are basically extra teeth supplied to our ancestors so that when they lost their other teeth, from lack of hygiene and rough treatment, there was an extra set to fill in.  
Now fast forward to today.  With the invention of the toothbrush and toothpaste, we don’t typically need an extra set of molars.  In addition, over time, our mouths have become narrower and smaller and most don’t have the space to accommodate 3 sets of molars.  Therefore, what tends to happen is that wisdom teeth grow in at an awkward angle.  This presents problems.  
What are the problems that wisdom teeth cause?  There are two major issues.  The first, is pericoronitis.  This is an infection of the tissue surrounding the wisdom teeth caused by trauma.  Since there is limited space in the back of the mouth, wisdom teeth often have excess tissue surrounding them.  As people are chewing, the tissue tends to get traumatized by the opposing teeth.  This causes swelling and infection and is often extremely painful.  The only treatment for pericoronitis is to take out the tooth causing the trauma.  This eliminates trauma and the infection will subside.  The second problem is decay.  Wisdom teeth are so far in the back of the mouth, that it is very difficult for most people to keep them properly cleaned.  Therefore, they tend to get decayed more quickly.  This eventually leads to infection.  
So, here is my recommendation based on what I was taught at the University of Florida as well as by various oral surgeons throughout the years.  Most people should have their wisdom teeth removed before the age of 25.  Here is the reasoning.  Most young people are healthy.  In addition, wisdom teeth are easier to remove before the roots are fully formed.  We know that as people age, manual dexterity diminishes.  Therefore, in elderly people, wisdom teeth are a double edged sword.  Not only, have they lost the dexterity to keep the wisdom teeth clean and free of infection, but now, removing wisdom teeth at that age becomes a major surgery.  The difference between a 25 year old recovering from wisdom teeth removal versus even a healthy 65 year old wisdom teeth removal is night and day.  Therefore, the younger you are when we remove wisdom teeth the easier it is.  We remove wisdom teeth to prepare for a healthier future.  I got my wisdom teeth removed when I was 18 and I am so thankful that my dentist recommended it and I don’t have to face that as I march on toward my “golden years.”  I hope this helped clear up the wisdom tooth debate, message me with any questions!
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What is Gum Disease?

1/27/2021

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So we know that gum disease is linked to COVID, but what exactly is gum disease?  Gum disease, or periodontitis, is a serious gum infection that destroys the tissue and bone around your teeth.  In addition, it can cause teeth to loosen or make your teeth fall out.  Scary, right?!?  However, periodontitis is largely preventable!  
Healthy gums should be firm, pale pink, and tight around the teeth.  Symptoms of infection, or periodontitis are swollen or puffy gums, bright red or purple gums, sore gums, gums that bleed, seeing pink or blood when you brush your teeth, bad breath, loose teeth, pain, and sometimes even puss.  
How does it start?  Gingivitis is the first stage of periodontal disease.  Gingivitis occurs when the bacteria in plaque build-up irritate the gums and cause them to become inflamed and bleed.  Gingivitis is completely reversible.  However, when left untreated by not getting regular dental cleanings, gingivitis can progress to periodontitis.  
Periodontitis occurs when the inner layer of the gum and bone pull away from the teeth and form pockets.  The pocket then collects debris and becomes infected.  This causes the body’s immune system spring to action.  So, now we have the toxins from the bacteria and plaque combined with the body’s immune system.  This combination starts to break down the jaw bone and ligaments that hold the teeth in place.  This creates a snowball effect where the pockets continue to get deeper and more and more bone is destroyed.  As more bone is lost, the teeth become loose.  This process is not reversible, but it is treatable.  
There are many contributing factors to periodontal disease such as poor oral hygiene, genetics, smoking, and illnesses that affect your immune system like diabetes.  Some medications are also risk factors for developing gum disease.  
Now the question becomes, how do we prevent it?  Early prevention is easy!  Brushing and flossing you teeth after meals and getting checked every 6 months at the dentist will help prevent periodontal disease.  If you already have periodontal disease though, that is another story.  Periodontal disease is irreversible, and once you have it, you’ll always have it.  The good news is that your dentist can help you keep it in remission and under control.  The only way to accomplish this is to get a deep cleaning followed by maintenance cleanings every three months called periodontal maintenance visits.  Research has shown that once the bacteria is completely cleaned out of the gum pockets by a deep cleaning, it takes approximately 90 days for the bacteria to get back down in the pocket and start breaking down the jaw bone and surrounding tissue again.  This is why we recommend 3 month periodontal maintenance visits.  We are trying to stay ahead of the jaw destruction, and research shows we need to clean the teeth and gums 90 days in order to have the highest chance for success.  
There have been many times where I have seen a patient and diagnosed gum disease and they have gotten the deep cleaning, and then they just disappear and fail to do maintenance cleanings afterwards.  After being in practice for a while, I started to see those patients turn back up.  They were confused as to why their gums were bleeding and inflamed again after they had gotten the deep cleaning done years ago.  The periodontal maintenance visits are as important as the original deep cleaning.  Without them, the disease cannot be kept in remission.  
I hope this helps you to understand!  In a quick rundown, gum problems start with reversible gingivitis and if left untreated progress to periodontal disease which is an irreversible disease that must be treated every 3 months to avoid future problems.  Now go brush and floss your teeth!  :)


Ariana Clayton, DMD
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Should I Risk A Trip To The Dentist?

1/13/2021

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I’m sure I’m not the only one this year who weighs my every action in life against the risk of getting COVID.  I feel like every decision I make is based on which is more likely to cause me to die, the activity I might miss, or the chance of me getting COVID.  Therefore, getting my yearly mammogram screening was a necessary evil and worth the risk of COVID.  But, I have not seen the inside of a salon since last March, hence my nails and hair are scary.  Everyone has their own pros and cons, but I thought I would share some research as to why the dentist should be on everyone’s necessary risk list.  It is particularly important for people over the age of 30!

One of the latest discoveries in this terrible disease is the effect of gum disease on COVID patients.  In a 3 month study, hospitalized COVID patients with high levels of IL-6, which is a protein produced by gum disease, were at significantly higher risk of suffering life threatening respiratory problems.  Since previous research has shown that IL6 is linked to other breathing problems such as pneumonia and chronic obstructive pulmonary disease, when researchers first began trying to figure out COVID, they looked to proteins that they already knew were linked to breathing problems. In Germany, they found that patients who were unable to breathe due to COVID tested positive for IL6.  The doctors were shocked that this tiny inflammatory protein could rob people of their ability to breathe.  Further research showed that patients with COVID and gum problems and hence higher IL6 levels, are 22 times more likely to suffer from acute respiratory problems and be placed on a ventilator.  Of the COVID patients placed on a ventilator, almost 80% have died.  

The researchers stress that their findings indicate a need for people who believe they may have gingivitis or more serious gum disease to get their teeth and gums checked and cleaned as soon as possible. Researchers are even urging doctors who screen COVID patients to take a moment with each patient and check them for gum disease, a diagnosis that would prompt them to be extra vigilant over watching the patient’s breathing.  Because, while we can’t stop COVID, we may now know something that can reduce its severity.  Since gum disease is the most under diagnosed problem in dentistry, the researchers are urging everyone who thinks it may even be a possibility to get tested and treated as soon as possible because its link to COVID is real and deadly.  

The CDC now predicts the virus will be the leading cause of death in the United States and since we have now confirmed that gum disease makes it even deadlier, it is imperative that if you’re worried that you may have any gum problems, your next trip to the dentist may actually change your life.  Since the CDC states that in the US, 47.2% of adults over the age of 30 have some form of gum disease, I know if I wasn’t already a dentist, a trip to the dentist would be the first thing on my list of, “definitely worth the risk.”  


Ariana Clayton, DMD


https://www.dentistrytoday.com/news/industrynews/item/6778-covid-19-patients-with-periodontitis-face-greater-risk-of-dying


https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html
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COVID and Your Teeth...

1/6/2021

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Can COVID Make Your Teeth Fall Out?

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Throughout the last year, we have all faced the unknowns of COVID. However, as time has passed, experts are learning more and more about the long term effects of COVID. Since the CDC now estimates that more than 15% of Americans have had COVID, it is time to examine the long term affects that we all could face. The CDC is still trying to determine the number of people who have long term effects after facing COVID, and part of the reason is that COV|D can affect every system in the body. So, while one person’s long term effect could be cardiovascular, another’s may be dermatological, and still another’s neurological. As I write this, there are clinics being set up around the country solely to treat the long term symptoms and try to understand more about them.
Being a dentist, I can only really discuss the effects of COVID on the mouth. I have done quite a bit of research, and the result is astonishing. There are thousands of reports of COVID affecting people’s teeth. There are many cases of people’s teeth becoming loose during, as well as, months after COVID. Even teenagers have reported their adult teeth, “falling out.” Currently, research is being done to determine the cause of this, but there are several theories.
The American Academy of Periodontology(The Gum Specialists) has reported that the tongue and oral mucosa are among the body parts that have the highest level of ACE2 receptors which are highly linked to COVID. Research indicates that these cells and their high level in the tongue, oral mucosa, and nasal mucosa are the basis for the loss of taste and smell being a common symptom of COVID. They are continuing research into these receptors to determine if tooth loss is a continuation of the virus. A study published in June 2020 by the National Institute of Health, already proved a connection between people suffering from severe cases of COVID and people with periodontal disease, but now the question is, in people who survive, does it reverse and cause more problems?
Another theory is that the cytokine storm or hyper- inflammatory reaction that we have heard so much about in regards to COVID can actually manifest in the mouth. We know that gum disease is very sensitive to hyper- inflammatory reactions, so the researchers are putting together the pieces of the puzzle that seem to show that people who already have even mild forms of gum disease can have significant worsening, or even more concerning, severe tooth issues, from the inflammatory response of the body to COVID.
We already know that 47% of people over the age of 30 have periodontal problems or gum disease. Therefore, physicians are now alerting the dental profession to be on the lookout for the long term effects of COVID. They are recommending that physicians and dentists work together with patients to really understand and, therefore, help patients with these long term and relatively unknown COVID effects. Our doctors are staying current on all the research so that we can help our patients in every way possible. Dr. Kokkas, along with our board certified Periodontist (gum specialist) is available to help anyone who has been affected by this horrible disease. Please do not hesitate to reach out with any concerns or questions. We are all learning how to fight the COVID battle together and I know that together we will win.
Ariana Clayton, DMD
Viviana Pitones-Rubio, E.G. Chávez-Cortez, Angélica Hurtado-Camarena, Anna González-Rascón, and Nicolás Serafín-Higuera,Is periodontal disease a risk factor for severe COVID-19 illness? https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC7303044/, June 2020.
US Dept of Health and Human Services. Long Term Effects of Covid. http://www.cdc.gov, November 13, 2020.
BriannaAbbott, Morethan15%ofAmericansHaveHadCovid.https://www.wsj.com/livecoverage/covid-2020-11-27/ card/vNkshCuxwSGLw7zkSx4z. November 27, 2020.
Wudan Yan, Their Teeth Fell Out, Was it Another Covid-19 Consequence? https://www.nytimes.com/2020/11/26/ health/covid-teeth-falling-out.html, November 28, 2020.

  
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    Author

    Born in Saint Petersburg, Florida, Ariana displayed bright intelligence from an early age, eventually becoming salutatorian for her graduating class at Dixie-Hollins High School. She went on to earn a bachelor's degree in nutritional sciences from the University of Florida at Gainesville, and continued her education to earn her dental degree in 2004 from the University of Florida College of Dentistry. It's worth noting that the College of Dentistry is ranked seventh among all dental schools in the United States, and it has an international reputation for the caliber of its graduates. Through continuing education programs, Dr. Clayton maintains her training on the most up-to-date and successful dental treatment techniques, and she strives to incorporate the best of newly available techniques into her practice. Sunshine Smile Designs is proud to offer this high level of care at an affordable price to many patients. Beyond her daily practice, Dr. Clayton is a volunteer for Dentistry From the Heart, a program that provides dental services at no cost to the indigent in Florida. Likewise, she also regularly attends mission trips to provide free dental services to blind and deaf children in an impoverished area of Jamaica. Ariana enjoys spending time with her nine-year-old son and her husband, who is also a University of Florida–trained dentist. Her artistic side is fulfilled by playing (and teaching) piano and by photography. She also enjoys travel, and one of her life goals is to visit all fifty states by recreational vehicle!

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True Care Dental is a general dentist office committed to providing dental excellence and affordability to the people of Ocala, Florida and the surrounding areas. 
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